In relation to chemotherapy treatment after liver resection could be regarded as neoadjuvant for the primary disease and adjuvant treatment is given after surgery for both liver metastases and colorectal cancer given the prognostic decisive role of liver metastases in long term survival the liver first approach has a theoretical advantage. Liver resection offers the best chance of cure for metastases confined to the liver however due to a paucity of randomized controlled trials its timing is controversial and a hotly debated topic this article reviews some of the main controversies surrounding the surgical management of colorectal cancer liver metastases crlm. Current controversies in the surgical management of colorectal cancer metastases to the liver risa small ba nir lubezky md and menahem ben haim md liver surgery unit department of surgery b tel . The factors affecting the decisions for the treatment for patients with metastatic colorectal cancer mcrc are related to the patient the tumor and the treatment itself current controversies in the management of metastatic colorectal cancer perioperative folfox4 chemotherapy and surgery versus surgery alone for resectable liver . This review highlights some of the key issues surrounding the oncosurgical management of colorectal liver metastases although great accomplishments have been made and the possibility of cure from metastatic disease now exists further work is needed to better identify optimal treatment strategies
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